By Mike Atkinson

What are pros and cons to assisted living facilities?
Pro: Personal Independence. In an assisted living setting, there are often more activities and clubs available to a resident. They are able to come and go as they please, which offers a much greater sense of control over their day to day life.

Con: Assisted Living is Expensive. Medicaid and Medicare often do not cover assisted living. Costs can range from $2,500 to $7,000 per month, depending on the area. This is unattainable for most people of average income.

What are pros and cons to nursing home living?
Pro: Can provide a level of care that would not be attainable at home, or with assisted living. A nursing home is able to provide total care, 24/7 for residents who may no longer be able to engage in any self-care or ADLs (activities of daily living).

Con: Loss of Personal Independence. Life in a nursing home tends to be very structured. Medication administration times, meal times, and activities times typically remain on a fixed schedule. This can become boring as years pass. Frequent visits and outings with friends and family are crucial to break this monotony.

What are some responsibilities of a nursing home caregiver?
Certified Nursing Aide (CNA): Assistance with all activities of daily living (ADLs) in accordance with the Plan of Care. A CNA works under the direction of the patient’s doctor and nurse to assist with any and all daily tasks required for safe, comfortable living.
A patient typical remains on a strict schedule. Consider what you do for yourself on a daily basis. Wake up. Get out of bed. Get washed up and dressed for breakfast. Use the bathroom. Brush your teeth. Go to breakfast. Eat. Go back to your room for a medication pass, possibly to an activity group. Use the bathroom. Go to lunch. Eat. Go back to your room for a medication pass, possibly to an activity group. Use the bathroom. Go to Dinner. Eat. Go back to your room for a medication pass, possibly to an activity group. Use the bathroom. Get dressed for bed. Get into bed.

The hard thing to imagine is that any given individual is likely to need full assistance with each step of this process. That in mind, consider that each CNA is likely to have 8-12 people per day for whom they need to complete all of these tasks, at the same time. As it stands, CNAs are significantly overworked, and understaffed. Systemically, great strides still need to be made to allow for a proper staff to patient ratio in the nursing home environment.

Licensed Practical Nurse (LPN): The nurse is responsible (with the help of the medical doctor and physical therapists), to formulate and carry out plan of care, which explains what specifically is needed for each individual on a daily basis. This includes current medications, treatments, meal plans, ambulatory restrictions, and extensive documentation of all of the above care.

What are some responsibilities of an assisted living caregiver?
(Disclaimer: I do not have personal experience as an employee of an assisted living home. I have taken care of many patients who happened to live in an assisted living environment, however that was on an individual basis. Based on that, and with some research, I’ve gathered the following)

Assisted living facilities differ in such details as number of residents, housing style, type of food service, extra amenities, and cost. Licensed facilities provide the basics of all meals, housekeeping, laundry, transportation to errands and appointments, recreational activities, and exercise and wellness programs.

Minimal assistance with ADLs can be provided, but often not relied upon. It would be the job of a CNA to assist with this. This may include occasional apartment/room visits to help with some tasks (reaching a high shelf, lifting a heavy laundry basket, limited bathroom assistance etc.). Guidance and oversight of medication may be available, but again, the resident will need to be responsible for their own medical care. It would be the job of a nurse to assist with this aspect if needed.

Think of this as independent living, but with a safety net. So long as an individual can do something for themselves, they will be expected too. Staff is here to assist, rather than to be relied upon.

Do you notice differences in living conditions?
Yes, significant differences. These are two very different environments, which serve very different purposes. In that respect, it is hard to draw a comparison.
A nursing home can be very hectic at times, but also must remain very structured and routine. This will feel more clinical. A resident may often feel like a patient in a facility, rather than a person at home. I would describe this like a hospital dressed up as a home.

An assisted living facility will be quieter, with a less structured atmosphere. This is done intentionally to make the environment feel more like a home to it’s residents. The focus is on doing things your way, on your time. I would describe this like an apartment, but with a helpful neighbor who gives you a hand when you need it.

Which facility do you prefer, in terms of bonding with the patient?
Nursing Homes.

Nursing home staff, particularly CNAs, often get a bad rap for being cold, or distant. I won’t disagree that this does occur, but I would argue that it isn’t the norm. This is a very difficult, defeating job. It is physically and emotionally exhausting.
I cannot imagine a single CNA who does not have a story about getting home after a shift, and breaking down to tears. This changes a person in a way which requires them to build up somewhat of an armor, which can be mistaken for a lack of empathy. But these people come back and do this every single day. They do things for these residents that most people cannot imagine. This creates a sense of trust, and a very close bond. Even with the more difficult, confused, or aggressive residents, there is an overwhelming sense of responsibility for their safety and well-being.

If you were in this situation, what facility would you prefer to live in?
This all depends on the level of care needed. I would like to care for myself at my highest possible level of function. However, through the normal aging process, a day will come when i am no longer able to do so. Perhaps I won’t be able to shower safely because of strength or balance issues. In this case, it would be safer for me to enter assisted living, so that I have staff available in an emergency.

Eventually my level of need may increase to the point where I need physical assistance, rather than monitoring. In that case, I would likely transition to Skilled Nursing care. Often times, the decision of which level of care to choose is not made based on preference, but on necessity. My only hope is that I will have the family support to guide me to the safest decision when that time comes.

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